Apparatus and method to access bone marrow

ABSTRACT

An apparatus and method for penetrating bone marrow is provided. The apparatus may include a housing such as a handheld body, a penetrator assembly, a connector that releasably attaches the penetrator assembly to a drill shaft, a gear mechanism, a motor and a power supply and associated circuitry operable to power the motor. The penetrator assembly may include a removable inner trocar and an outer penetrator or needle. It may also include a grooved trocar that allows bone chips to be expelled as the apparatus is inserted into bone marrow. Various connectors are provided to attach the penetrator assembly to the drill shaft.

RELATED APPLICATION

This application is a divisional application of U.S. patent applicationSer. No. 10/449,476, filed May 30, 2003, and entitled “Apparatus andMethod to Access the Bone Marrow”, which claims priority to U.S.Provisional Patent Application Ser. No. 60/384,756, filed May 31, 2002,and entitled “Apparatus and Method to Provide Access to Bone Marrow”

This application is copending to patent application entitled “Apparatusand Method to Provide Emergency Access To Bone Marrow”, Ser. No.10/449,503, filed May 30, 2003; and copending to patent applicationentitled “Apparatus and Method to Access the Bone Marrow for Oncologyand Stem Cell Applications”, Ser. No. 10/448,650, Filed May 30, 2003,which claims priority from the same provisional application.

TECHNICAL FIELD

The present invention is related in general to a medical device toaccess the bone marrow and specifically to an apparatus and method forpenetrating the bone marrow with a powered drill and inserting apenetrator or needle.

BACKGROUND OF THE INVENTION

Every year, millions of patients are treated for life-threateningemergencies in the United States. Such emergencies include shock,trauma, cardiac arrest, drug overdoses, diabetic ketoacidosis,arrhythmias, burns, and status epilepticus just to name a few. Forexample, according to the American Heart Association, more than1,500,000 patients suffer from heart attacks (myocardial infarctions)every year, with over 500,000 of them dying from its devastatingcomplications.

An essential element for treating all such emergencies is the rapidestablishment of an intravenous (IV) line in order to administer drugsand fluids directly into the circulatory system. Whether in theambulance by paramedics, or in the emergency room by emergencyspecialists, the goal is the same—to start an IV in order to administerlife-saving drugs and fluids. To a large degree, the ability tosuccessfully treat such critical emergencies is dependent on the skilland luck of the operator in accomplishing vascular access. While it isrelatively easy to start an IV on some patients, doctors, nurses andparamedics often experience great difficulty establishing IV access inapproximately 20 percent of patients. These patients are probedrepeatedly with sharp needles in an attempt to solve this problem andmay require an invasive procedure to finally establish an intravenousroute.

A further complicating factor in achieving IV access occurs “in thefield” e.g. at the scene of an accident or during ambulance transportwhere it is difficult to see the target and excessive motion makeaccessing the venous system very difficult.

In the case of patients with chronic disease or the elderly, theavailability of easily-accessible veins may be depleted. Other patientsmay have no available IV sites due to anatomical scarcity of peripheralveins, obesity, extreme dehydration or previous IV drug use. For thesepatients, finding a suitable site for administering lifesaving drugsbecomes a monumental and frustrating task. While morbidity and mortalitystatistics are not generally available, it is known that many patientswith life-threatening emergencies have died of ensuing complicationsbecause access to the vascular system with life-saving IV therapy wasdelayed or simply not possible. For such patients, an alternativeapproach is required.

SUMMARY OF THE INVENTION

In accordance with teachings of the present invention, an apparatus andmethod for gaining rapid access to the bone marrow is provided.

In one embodiment of the invention an apparatus for penetrating a bonemarrow is provided that includes a housing and a penetrator assembly.The penetrator assembly is operable to penetrate the bone marrow, havinga removable inner trocar and an outer penetrator. A connector operableto releasably attach the penetrator assembly to a drill shaft isincluded. The drill shaft is operable to connect the penetrator assemblyto a gear assembly. The gear assembly is operable to engage and rotatethe drill shaft. A motor operable to engage the gear assembly and drivethe penetrator into the bone marrow by rotation of the drill shaft and apower supply and associated circuitry operable to power the motor arealso included.

In another embodiment of the invention an apparatus for penetrating abone marrow is provided that includes a housing and a penetratorassembly, operable to penetrate the bone marrow. A connector operable toreleasably attach the penetrator assembly to a drill shaft, the drillshaft operable to connect the penetrator assembly to a reduction gearassembly is included. A reduction gear assembly operable to engage androtate the drill shaft and a motor operable to engage the reduction gearassembly and drive the penetrator into the bone marrow by rotation ofthe drill shaft are also included. A power supply and associatedcircuitry operable to power the motor are also provided.

In one embodiment of the invention a penetrator assembly operable toprovide access to a bone marrow comprising an outer penetrator and aremovable inner trocar operable to penetrate the bone marrow is providedA connector operable to releasably attach the penetrator assembly to apower drill is also included.

In another embodiment of the invention a penetrator assembly operable toprovide access to a bone marrow comprising an outer penetrator and aremovable inner trocar operable to penetrate the bone marrow isprovided. The inner trocar includes a handle, the handle including agrasping means that allows a user to grasp and manipulate the device.The outer penetrator includes a handle, the handle including a graspingmeans, and also includes a flange operable to engage an insertion siteproximate the bone marrow. A connector operable to releasably attach thepenetrator assembly to a power drill is also provided. The inner trocaris operable to releasably engage the connector.

In one embodiment of the current invention a method of accessing a bonemarrow is provided that includes inserting a penetrator assembly intothe bone marrow by means of a powered apparatus, detaching the poweredapparatus from the penetrator, removing an inner trocar from an outerpenetrator of the assembly and attaching a right angle connector to theouter penetrator.

In another embodiment of the current invention a method of accessing abone marrow is provided that includes inserting a penetrator assemblyinto the bone marrow by means of a powered apparatus, detaching thepowered apparatus from the penetrator, removing an inner trocar from anouter penetrator of the assembly and attaching an adapter suitable toconvey medications or fluids to the bone marrow.

In yet another embodiment of the current invention a method ofmanufacturing an apparatus operable to penetrate a bone marrow isprovided that includes manufacturing a housing having a connectoroperable to releasably attach a penetrator assembly to a drill shaft, adrill gear assembly, a gear assembly operable to engage and rotate thedrill shaft, a motor operable to engage the gear assembly and drive apenetrator assembly into the bone marrow and a power supply andassociated circuitry operable to power the motor and manufacturing apenetrator assembly operable to releasably attach to the connector.

In a further embodiment of the current invention, a kit for use inpenetrating a bone marrow in an extremity is provided that includes acarrying case, an apparatus for penetrating the bone marrow including ahousing and penetrator assemblies operable to penetrate the bone marrow,a removable inner trocar and an outer penetrator forming portions of atleast one of the penetrator assemblies, at least one connector operableto releasably attach the penetrator assemblies to a drill shaft, a gearassembly operable to engage and rotate the drill shaft, a motor operableto engage the reduction gear assembly and drive at least one of thepenetrator assemblies into the bone marrow and a power supply andassociated circuitry to power the motor and a strap operable toimmobilize the outer penetrator to a site in an extremity.

BRIEF DESCRIPTION OF THE DRAWINGS

A more complete and thorough understanding of the present embodimentsand advantages thereof may be acquired by referring to the followingdescription taken in conjunction with the accompanying drawings, inwhich like reference numbers indicate like features, and wherein:

FIG. 1A is a schematic drawing showing an isometric view of oneembodiment of the present invention;

FIG. 1B is a schematic drawing showing an isometric view of oneembodiment of the present invention;

FIG. 2A is a schematic drawing showing an isometric view of oneembodiment of the present invention;

FIG. 2B is a schematic drawing showing an isometric view of oneembodiment of the present invention;

FIG. 3A-C illustrates a side and cross-sectional view of one embodimentof the present invention;

FIG. 4A-C illustrates various alternate embodiments of a reduction gearmechanism that may be included in an embodiment of the presentinvention;

FIG. 5A-C illustrates one embodiment of a penetrator assembly of thepresent invention;

FIGS. 6A-C illustrate various alternate embodiments of a penetratorassembly connector of the present invention;

FIG. 7A illustrates one embodiment of a penetrator assembly of thepresent invention;

FIG. 7B illustrates a cross-sectional view of one embodiment of apenetrator assembly of the present invention;

FIG. 7C illustrates one embodiment of an inner trocar in cross sectionof the present invention;

FIG. 7D illustrates one embodiment of an outer penetrator in crosssection of the present invention.

FIG. 7E-G illustrate examples of release mechanisms of the presentinvention.

FIG. 8A illustrates one embodiment of a tip of a penetrator assembly ofthe present invention;

FIG. 8B illustrates one embodiment of a tip of a penetrator assembly ofthe present invention;

FIG. 9 illustrates one embodiment of a kit to access the bone marrow ofthe present invention; and

FIG. 10 illustrates one embodiment of a connector to attach to an outerpenetrator of the present invention.

DETAILED DESCRIPTION OF THE INVENTION

Preferred embodiments of the invention and its advantages are bestunderstood by reference to FIGS. 1A-10 wherein like numbers refer tosame and like parts.

Various examples of an apparatus operable to access the bone marrow inaccordance with the present invention are shown generally in FIGS. 1Aand 1B at 10. Apparatus 10 as shown in FIGS. 1A and 1B generallyincludes housing 12 and penetrator assembly 14. Housing 12 includeshandle 16 that is sized and contoured to fit the hand of an operator.Handle 16 may include on/off switch 22 and safety 24. Penetratorassembly 14 includes outer penetrator 18, inner trocar (not expresslyshown) and penetrator assembly connector 20.

FIGS. 2A and 2B illustrate an alternate embodiment of the presentinvention. Apparatus 10 a generally includes housing 12 and penetratorassembly 14 a. Housing 12 includes handle 16 that is sized and contouredto fit the hand of an operator. Handle 16 may include an on/off switch22. Penetrator assembly 14 a includes outer penetrator 18, inner trocar(not expressly shown) and penetrator assembly connector 20. Penetratorassembly 14 a may include penetrator shield 26. An outer penetrator mayinclude either a trocar, a needle, a cannula, a hollow tube, a drill bitor a hollow drill bit.

FIGS. 3A and 3B illustrate yet another embodiment of the presentinvention. Apparatus 10 b generally includes housing 12 and a penetratorassembly (not expressly shown). Housing 12 includes handle 16 and on/offswitch 22. Penetrator assembly may include penetrator (not expresslyshown) and a connector, for example a pentagonal connector 20 as shownin FIG. 3A. As shown in FIG. 3B, housing 12 encloses motor 30, powersupply 32, for example four or more AA batteries, motor connecting wires34 between power supply 32 and motor 30 and switch connecting wires 36between on/off switch 22 and power supply 32. The power supply to theapparatus may be any suitable number of AA batteries or any other typeof battery, a source of direct current, a source of alternating currentor a source of air or gas power. The motor may be reciprocating orrotational. Thruster bearing 45, for example a washer, may be locatedadjacent to housing 12 where drill shaft 40 exits housing 12. Thrusterbearing 45 prevents the thrust or penetration force of drilling frombeing placed on gear assembly 38 as penetrator is drilled into bone.FIG. 3C shows one embodiment of the invention where drill shaft 40 maybe separated into two interdigitating pieces at 42 in order to allow thetwo ends of drill shaft 40 to slide in and out as bone is penetrated toavoid applying excessive force to a gear assembly.

In FIG. 3B gear assembly 38 is coupled to motor 30. Gear assembly 38 maybe a reduction gear assembly such as that shown in FIG. 3B thatfunctions to reduce the revolutions per minute (RPMs) between the motorand drill shaft 40 and to increase drill shaft torque. Depending on thetype of motor employed in the invention, gear assembly may or not be ofthe reduction type.

By way of example and not limitation, a reduction gear assembly, forexample a worm gear assembly is shown in more detail in FIG. 4A and mayinclude first connector 43 that connects shaft 44 of motor 30 to wormgear 46. Worm gear 46 may engage spur gear 47. Reduction gear assembly38 may be used to decrease the RPMs between the motor and penetratorassembly to provide an optimum RPM at the point of insertion ofpenetrator assembly into bone. Reduction gear assembly 38 may also beused to increase the torque of drill shaft and drilling power.

FIG. 4B illustrates one embodiment of reduction gear assembly 38 whereina first spur gear 47 engages a second spur gear 49. FIG. 4C illustratesan alternate embodiment of reduction gear assembly 38 wherein spur gear47 is offset from mitered gear 48 that may be preferable in someembodiments of the present invention. Other gears may be used in areduction gear assembly, for example a planetary gear (not expresslyshown) that may be used alone or in combination with a worm gear or aspur gear. In one embodiment of the current invention, gear assembly maybe any suitable gear arrangement and is not limited to a reduction gearassembly.

FIGS. 5A-5C illustrate one embodiment of a penetrator assembly 55operable to penetrate a bone marrow, having a removable inner trocar 50and an outer penetrator 52. Also shown in FIG. 5A is a penetrator shield26 that may be used to shield penetrator assembly 55 from inadvertentengagement and also serves to preserve needle sterility. In someembodiments outer penetrator 52 may be a type of needle or cannula. FIG.5B illustrates outer penetrator 52 may include a male connecting piece56 operable to engage a complementary female connecting piece 54 ofinner trocar 50. Adjacent to male connecting piece 56 is connectingpiece locking mechanism 58 that locks into position on female connectingpiece 54. Alternatively outer penetrator may include a female connectingpiece suitable to engage a complementary male connecting piece of aninner trocar. Luer lock attachment 57 is coupled to male connectingpiece 56 for connection to an intravenous tubing or syringe after theouter penetrator is positioned in the bone marrow. Male connecting piece56 and female connecting piece 54 may also be of the luer-lock type.Inner trocar 50 includes stylet 53 that keeps outer penetrator 52 fromgetting plugged with debris created during drilling. Stylet 53 acts incombination with cannula portion 51 of outer penetrator. Outerpenetrator 52 may include flange 60 that abuts or interfaces the skin ofan insertion site and may be used to stabilize a penetrator assembly atthe time of insertion. Penetrator assembly 55 may include various typesof connectors, such as connector 62 that may be used to connectpenetrator assembly 55 to a powered drill. Connector 62 may bepentagonal as shown in FIGS. 5A and 5C.

In one embodiment, the invention may include a specialized connectorbetween the penetrator assembly and a powered drill. The connectorperforms at least two functions, a connecting function and a releasingfunction. The connecting function may be performed by various mechanismssuch as a pentagonal male-female fitting or various lock-and-keymechanisms such as one that may include a combination or series ofgrooves and ridges or bars that match and interlock on a connector.

The releasing function may be performed by an O-ring connection, amagnetic connector, a chuck release mechanism, or a ball and detentmechanism with and without a spring. In one embodiment the releasingfunction may occur by means of a trigger mechanism whereby a triggercomes in contact with a holding mechanism and releases a penetrator orneedle. In another embodiment a connecting mechanism may also include atrigger or retractable shield rod that slides up and contacts a holdingmechanism or clamp that breaks away and releases a penetrator or needleafter contact (not expressly shown).

FIGS. 6A-C illustrate alternate embodiments of connectors operable toreleasably attach penetrator assembly 55 to powered drill apparatus 10.FIG. 6A illustrates penetrator assembly connector 62 wherein connector62 is formed to fit into a connector receptacle 64 and releasably lockinto place. In this example, connector 62 and connector receptacle 64are pentagonal shaped. Advantages of this embodiment may be the ease ofattachment and removal of penetrator assembly 55 from powered drillapparatus 10. Penetrator assembly connector 62 may be formed from metalor plastic.

FIG. 6B illustrates an alternate embodiment of penetrator assemblyconnector wherein a female pentagonal receptacle 65 is operable toengage pentagonal connecting piece 66 attached to powered drillapparatus 10. FIG. 6C illustrates a further embodiment of a penetratorassembly connector wherein penetrator assembly connector 68 is aproprietary design having a pattern of ridges or bars 70 that engage amatching pattern of slots 71 on a connecting receptacle 72. Examplepenetrator assembly connectors may include any type of lock and keydesign or a pentagonal design. Penetrator assembly connectors of anytype may be held in place by either a magnet, an O-ring connector or aball and detent mechanism with or without a spring (not expresslyshown).

In one embodiment, the penetrator assembly may include an outerpenetrator such as a cannula, needle or hollow drill bit which may be ofvarious sizes. Needles may be small (for pediatric patients), medium(for adults) and large (for over-sized adults). Penetrator, cannulas orneedles may be provided in various configurations depending on theclinical purpose for needle insertion. For example, there may be oneconfiguration for administering drugs and fluids and an alternateconfiguration for sampling bone marrow or for other diagnostic purposesalthough one needle configuration may be suitable for both purposes.Needle configuration may vary depending on the site chosen for insertionof a needle.

FIGS. 7A-7D illustrate one embodiment of a penetrator assembly 80 thatincludes a removable inner trocar 82 and an outer penetrator 84. FIG. 7Billustrates a cross-sectional view of one embodiment of a penetratorassembly having a removable inner trocar 82 and an outer penetrator 84.Outer penetrator 84 includes flange 86 and flange groove 88. Flange 86may be used to stabilize penetrator assembly 80 against the skin of aninsertion site. Flange groove 88 is operable to engage plasticpenetrator cover 94. The surface of outer penetrator may include aseries of discs formed along a longitudinal axis, a series of ridges orsome other grasping means. This surface allows an operator to grasp theouter penetrator with two fingers and easily disengage the inner trocar82 from outer penetrator 84. Outer penetrator 84 includes a penetratorcannula 96 that is hollow when stylet 100 is removed.

In FIG. 7C inner trocar 82 includes handle 98 that may have a surfacesuch as a series of discs formed along a longitudinal axis of thetrocar, or a series of ridges or some other grasping means. Handle 98allows an operator to easily grasp and manipulate inner trocar 82 anddisengage it from outer penetrator 84. Inner trocar 82 also includesstylet 100. Stylet 100 exits an end of penetrator cannula 96 when innertrocar 82 is inserted into outer penetrator 84 Stylet 100 includes acutting tip and is operable to penetrate bone marrow. In one embodimentof the invention, inner trocar 82 may include metal disc 95 to allow amagnetic connection between penetrator assembly and powered drill.Receptacle 97 may also engage a penetrator assembly male-type connectorpiece operable to connect penetrating assembly to a powered drill, orany other suitable connector.

FIGS. 7E-7G illustrate example release mechanisms that may be coupled toa connector and included in penetrator assembly 80. FIG. 7E illustratesone embodiment of a magnetic release mechanism where magnetic disc 70 isincluded in inner trocar 82. In this embodiment magnetic disc 70 is atthe base of open area or receptacle 97. In alternative embodiments amagnetic disc could be included with a pentagonal connector or a lockand key connector or any other suitable connector.

FIG. 7F illustrates another embodiment of a release mechanism whereO-ring 72 is included in trocar 98 as part of a connector. In thisembodiment O-ring 72 is in the wall of receptacle 97. O-ring 72 is ableto engage a lock and key connector, a pentagonal connector or any othersuitable connector.

FIG. 7G illustrates yet another embodiment of a release mechanism usingball and detent mechanism 74. In this embodiment ball and detentmechanism 74 is in the wall of receptacle 97. Ball and detent mechanism74 is able to engage a lock and key connector, a pentagonal connector orany other suitable connector.

FIG. 8A illustrates an embodiment of an outer penetrator needle 110 andinner stylet 112. Cutting tip 114 of outer penetrator needle 110 and tipof inner stylet 112 are operable to penetrate bone marrow. In oneembodiment of the invention the outer penetrator needle and the innerstylet are ground together as one unit in the manufacturing process toensure that the two pieces are an exact fit and act as a single drillingunit.

FIG. 8B illustrates another embodiment of an outer penetrator needle 96and an inner stylet 100. Cutting tip 102 of inner stylet 100 is operableto penetrate bone marrow. Inner stylet may also include a longitudinalgroove 104 that runs along the side of stylet 100 that allows bone chipsand tissue to exit an insertion site as a penetrator assembly is drilleddeeper into bone. Outer penetrator or needle 96 includes cutting tip 106that facilitates insertion of outer penetrator or needle 96 andminimizes damage to outer penetrator or needle 96 as penetrator assembly55 is inserted into bone marrow. In one embodiment of the invention theouter penetrator needle and the inner stylet are ground together as oneunit in the manufacturing process to ensure that the two pieces are anexact fit and act as a single drilling unit.

FIG. 9 illustrates one embodiment of kit 120 to penetrate bone marrow.Kit 120 includes apparatus 10 for penetrating bone marrow, alternativesizes of penetrator assemblies 122, and strap 124 suitable to immobilizean outer penetrator on an extremity during insertion of penetratorassembly 122. Carrying case 125 is also included.

Once an outer penetrator or needle is inserted into a bone, it may beconnected to a source of intravenous fluids or medication. FIG. 10illustrates an example of a connector that may be used to connect theouter penetrator of a penetrator assembly to tubing 130, for example anintravenous tubing for providing intravenous fluids or medications to aperson. Outer penetrator 84 is inserted into the bone marrow of anextremity. Right angle connector 132 is then used to connect intravenoustubing 130 to outer penetrator 84. Right angle connector has theadvantage of allowing tubing to be connected to an outer penetrator orneedle at an angle that will not kink or pinch off the lumen of thetubing. Other connectors or adapters may also be used to connect anouter penetrator to an intravenous tubing, another kind of tubing or toa syringe for use in providing medication or fluids to a person or foruse in withdrawing a sample of blood from the bone marrow.

A method for providing access to the bone marrow includes using apowered drill, capable of reciprocal or rotational motion, to insert apenetrator assembly that includes an outer penetrator and an innertrocar into a bone marrow cavity. The powered drill is then releasedfrom the penetrator assembly and the inner trocar is grasped and removedfrom the outer penetrator. A connector present on the end of the outerpenetrator, for example a luer lock connector, is then available forattachment to either an adapter, such as a right angle connector ordirectly to an intravenous tubing or syringe.

Although the present invention and its advantages have been described indetail, it should be understood that various changes, substitutions andalternations can be made herein without departing from the spirit andscope of the invention as defined by the following claims.

1. A method of accessing bone marrow comprising: inserting a penetratorassembly into the bone marrow using a powered apparatus; releasing thepowered apparatus from the penetrator assembly; and attaching a rightangle connector to the penetrator assembly.
 2. The method of claim 1further comprising: removing an inner trocar from an outer penetrator ofthe penetrator assembly; and attaching the right angle connector to theouter penetrator.
 3. The method of claim 2 wherein removing the innertrocar from the outer penetrator further comprises grasping a handleformed on the inner trocar to disengage the inner trocar from the outerpenetrator.
 4. The method of claim 1 wherein detaching the poweredapparatus from the penetrator assembly further comprises releasing aconnector attached to the penetrator assembly and the powered apparatus.5. A system for penetrating a bone marrow comprising: a housing; apenetrator assembly operable to penetrate the bone marrow; thepenetrator assembly including a removable inner trocar and an outerpenetrator; a first connector operable to releasably attach thepenetrator assembly to a drill shaft; the drill shaft operable toconnect the penetrator assembly to a gear assembly; a gear assemblyoperable to engage and rotate the drill shaft; a motor operable toengage the gear assembly and drive the penetrator assembly into the bonemarrow by rotation of the drill shaft; a power supply and associatedcircuitry operable to power the motor; a second connector operable toconnect the outer penetrator to at least one section of tubing; and thesecond connector comprising a right angle connector.
 6. The system ofclaim 5 wherein the penetrator assembly further comprises a penetratorshield.
 7. The system of claim 5 wherein the first connector furthercomprises a pentagonal connector.
 8. The system of claim 5 wherein thefirst connector further comprises a series of grooves and bars thatmatch and interlock.
 9. The system of claim 5 wherein the firstconnector further comprises a magnetic connector.
 10. A system forpenetrating a bone marrow comprising: a housing; a penetrator assemblyoperable to penetrate the bone marrow; a first connector operable toreleasably attach the penetrator assembly to a drill shaft; the drillshaft operable to connect the penetrator assembly to a gear assembly; agear assembly operable to engage and rotate the drill shaft; the motoroperable to engage the gear assembly and drive the penetrator into thebone marrow by rotation of the drill shaft; a power supply andassociated circuitry operable to power the motor; and a second connectoroperable to connect a portion of the penetrator assembly to at least onesection of tubing.
 11. The system of claim 10 wherein the secondconnector further comprises a right angle connector.
 12. The system ofclaim 10 wherein the penetrator assembly further comprises a penetratorshield.
 13. The system of claim 10 wherein the first connector furthercomprises a pentagonal connector.
 14. The system of claim 10 wherein thefirst connector further comprises a series of grooves and bars thatmatch and interlock.
 15. The system of claim 10 wherein the firstconnector further comprises a magnetic connector.
 16. An apparatuscomprising: a penetrator assembly operable for insertion into bonemarrow; and a right angle connector operable to couple the penetratorassembly to a source of intravenous fluid.
 17. The apparatus of claim 16wherein the penetrator assembly further comprises an inner trocar and anouter penetrator.
 18. The apparatus of claim 17 wherein the outerpenetrator further comprises a cannula.
 19. The apparatus of claim 16further comprising: a handle attached to the inner trocar; and thehandle operable to remove the inner trocar from the outer penetrator.20. An apparatus for connecting a penetrator after insertion into bonemarrow to a source of intravenous fluids comprising a right angleconnector and at least one section of tubing.
 21. The apparatus of claim20 further comprising the penetrator selected from the group consistingof a cannula, a needle or a hollow drill bit.
 22. The apparatus of claim20 wherein the penetrator further comprises a flange operable tostabilize the penetrator during insertion into the bone marrow.